tbuckley/cabot-search huggingface dataset:
Pathologic complete responses and overall survival after neoadjuvant chemotherapy for muscle-invasive bladder cancer: Analyzing the impact of race.
Authors: Arya Mariam Roy, Changchuan Jiang, Stuthi Perimbeti, Karan Jatwani, Gurkamal S. Chatta, Dharmesh Gopalakrishnan
Journal: Journal of Clinical Oncology (2022)

146 Background: Neoadjuvant chemotherapy (NAC) has been demonstrated to improve overall survival (OS) after radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC). We compared pathologic complete response (PCR) rates and OS after NAC between African American (AA) and Caucasian patients with MIBC. Methods: We queried the National Cancer Database for Caucasian and AA patients with localized MIBC (cT2-T4aN0M0) with urothelial histology who received NAC + RC between 2007 and 2018. We excluded patients who belonged to other races, had nodal or distant metastases, non-urothelial histology, did not receive NAC, or had missing pathological data. Logistic regression was used to analyze PCR and residual disease (RD) and Cox proportional hazards regression to analyze OS, with adjustment for age at diagnosis, race, stage, grade, insurance, treatments received, and comorbidities. STATA/IC 16.0 was used for analysis and a two-sided p-value &lt; 0.05 was considered significant. Results: A total of 7008 Caucasians and 424 AAs with MIBC were identified. 75.6% were males and 24.4% were females. Among those who received NAC, only 12.6% (n = 933) attained PCR and 87.4% (n = 6499) had RD. Among Caucasians, 12.76% (n = 894) attained PCR and 87.24% (n = 6114) had RD. Among AAs, 9.2 % (n = 39) had PCR and 90.8% (n = 385) had RD. AA had more likelihood of attaining PCR when compared to Caucasians, but was not statistically significant (OR = 1.35, 95% CI = 0.966 – 1.90, p = 0.078). The median OS of patients with PCR and RD were 144 and 47 months respectively. Patients who had RD had significantly higher mortality risk when compared to those who attained PCR (HR = 3.67, 95% CI = 3.14-4.29, p &lt; 0.01). In the PCR group and RD groups, AA vs Caucasian race was not associated with a statistically significant mortality benefit in univariate or multivariate analysis. Within PCR and RD groups, AAs were found to have mortality risk compared to Caucasians (PCR group: HR = 1.53, 95% CI = 0.2-1.43, p = 0.21 and RD group: HR = 1.07, 95% CI = 0.93- 1.2, p = 0.34). Conclusions: PCR with NAC in localized MIBC was associated with significantly improved overall survival. AA or Caucasian race was not independently predictive of PCR or OS after NAC in MIBC.
Mental health symptom severity and health care utilization in adolescent and young adult cancer survivors.
Authors: Nikita V. Baclig, W. Scott Comulada, Patricia A. Ganz
Journal: Journal of Clinical Oncology (2022)

229 Background: Adolescent and Young Adult (AYA) cancer survivors experience psychological sequelae, yet causal pathways between AYA cancer, mood disorders, and mental healthcare remain unclear. The 2019 National Health Interview Survey (NHIS) applies the Patient Health Questionnaire-8 item (PHQ8) and Generalized Anxiety Disorder-7 item (GAD7), providing validated evaluation of mental health (MH) in a national sample. We investigated how AYA cancer history affects MH symptoms and MH care utilization. Methods: Descriptive statistics evaluated depression (PHQ8), anxiety (GAD7), use of MH medications, and receipt of psychotherapy in three groups: adults with AYA cancer history, adults with Older Adult (OA) cancer history, and cancer-free adults. Structural Equation Modeling (SEM) was used to estimate cancer survivorship impact on medication use and receipt of therapy (total effects), as well as direct/indirect effects through depression and anxiety (mediated effects). Results: AYA cancer survivors had higher mean PHQ8 (3.64, 2.80, 2.43, p &lt; 0.001) and GAD7 (3.05, 1.90, 2.05, p &lt; 0.001) compared to OA survivors and cancer-free adults. They reported more medication use for MH (24.8%, 21.0%, 15.2%, p &lt; 0.001), and received therapy more often (14.0%, 8.6%, 9.5%, p = 0.001). Total effects models showed AYA survivors were more likely to have received therapy (OR 1.55, 95% CI 1.20-2.00) and to have taken medications (OR 1.84, 95% CI 1.49-2.28) compared to cancer-free adults. Mediated models examined indirect (mediated by MH symptoms) and direct (residual) pathways. All indirect partial paths (regressor to mediator or mediator to outcome) showed large, significant effects (p &lt; 0.001), except for regression of GAD7 on OA survivors. Direct paths showed large, significant effects of AYA and OA survivorship on medication use, but small nonsignificant effects on therapy. Indirect full paths (regressor to outcome through mediators) demonstrated smaller effects than direct pathways, but overall larger effects for AYA survivors than OA survivors. Conclusions: AYA survivors experience worse MH symptoms and are more likely to utilize MH care than OA survivors and cancer-free adults. Effects of cancer survivorship on MH care utilization were mediated through MH symptom severity. Mediated effects were larger for AYA survivors than OA survivors.[Table: see text]
Use of non-curative oncological care in osteosarcoma.
Authors: Kevin McMahon, Vincent Eaton, Gregory Cichon, Julia Griffin, Mary Dahl, Peter T. Silberstein, Kate McKillip
Journal: Journal of Clinical Oncology (2022)

78 Background: Osteosarcoma is the most common form of bone cancer, but the utilization of palliative care (PC) in patients with this cancer has not previously been investigated in the NCDB. Methods: This study retrospectively evaluated the use of palliative care in osteosarcoma patients diagnosed and recorded in the National Cancer Database (NCDB) between 2004 and 2017. Patients were identified by the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) coding, and patients with other malignancies or missing follow-up data were excluded. Cross tabulations with Chi-square analysis were performed to evaluate frequencies of different patient and tumor characteristics. Multivariable logistic binary regression was performed to evaluate relationships between patient and tumor characteristics and the use of palliative care. Results: A total of 7498 patients were analyzed with 2.8% of all patients diagnosed having any form of palliative care utilization. Of this group, 53.37% received PC within the first 12 months after diagnosis. Those receiving PC were most likely to be treated with non-curative surgery, radiation, chemotherapy, or any combination of these modalities (56.7%). No significant increase in PC utilization was noted over the 13-year duration of this study. Palliative care usage was increased in patients with greater tumor diameter, tumors in the bones of the trunk &amp; skull, or stage IV tumors. Palliative care usage was decreased in patients living 25-49 miles of their treatment facility, those living in pacific states, those with chondroblastic osteosarcoma, or those with private insurance. Conclusions: Palliative care use in patients with osteosarcoma increases with tumor stage, tumor size, or more proximal tumors, but overall utilization remains markedly low. Future studies should further define these patterns of care and help expand the utilization of PC.
Outcomes of a quality improvement project integrating an EHR (electronic health record) for improved adverse drug reaction (ADR) communication at an adult outpatient cancer infusion center.
Authors: Vidya Kollu, Paul Letendre, Kurt R. Oettel, Leanne Markos, Piyush Srivastava
Journal: Journal of Clinical Oncology (2022)

372 Background: An adult oncology practice achieved 41% compliance with communication of ADRs involving infusion drugs to ordering provider during the year 2020. We aim at achieving communication of ADRs to ordering provider with a goal compliance rate of 75% over a period of 8 months. Methods: We assembled an interdisciplinary team comprising of medical oncologists, fellows, clinical nurse managers, infusion &amp; clinic nurses, information technology (IT))providers and a clinical pharmacist. We reviewed ADRs occurring between April-December of 2021 in adult patients receiving outpatient infusion therapy at our institution. We created a current-state process map of ADRs in our infusion center. We identified issues that needed to be addressed including no clear standard for documenting or reporting an infusion reaction, no standard process was in place for proper notification to all parties involved nor was there a consistent location in the EHR regarding the description of events that took place. Acknowledgment by ordering provider to an ADR was used as a primary outcome measure. The RL6 (internal tracking system) patient safety events reported was used as a process measure. PDSA cycle 1 January 2021:We implemented a new flowsheet section in the EHR titled “Adverse Drug Reaction”. We created a smart phrase for clarification of documentation, when used will pull information from the flowsheet section into the note. Education was provided to nursing on this new standardized process. Clinicians were educated where to find this information as a standardized location within the EHR. The ordering provider was notified when an ADR occurred by having the infusion nurse document a clinical support note that is routed to the provider’s EHR in-basket. PDSA cycle 2 June 2021: Once nursing documented an ADR, an automated message was sent to all the care-team members via the ADR event folder within the EHR in-basket. The nursing staff then would add the ADR orders group to the treatment plan for clinician review. An alert was generated which prompted the clinician to acknowledge the ADR within the Beacon plan thereby alerting the nursing team if any changes were made. Results: In 2021 there were 73 ADR events that have occurred in Infusion Services. Our interventions were associated with an 80% improvement in communication of ADRs to ordering providers and 35% increase in reporting ADR within our internal tracking system. Conclusions: Developing a standardized ADR process enhanced communication of ADRs to the ordering providers as our intervention was associated with an 80% improvement in communication of ADRs over a 8-month period. Involving all major stakeholders, especially the staff working in information technology services, resulted in exponential results demonstrating the potential future solutions within the EHR.
Association of disability with long-term noncompliance of breast cancer screening.
Authors: Hyo Jung Tak, Min Sok Lee, Ya-Chen Tina Shih
Journal: Journal of Clinical Oncology (2022)

118 Background: Although the U.S. Preventive Services Task Force (USPSTF) recommends a biennial screening mammography for women aged 50 to 74 years at average risk for breast cancer, 24.6% of screening-eligible women do not follow the recommendation. Very little is known regarding the association between various types of disabilities and subsequent breast cancer screening behaviors following the initiation of screening mammography. This study examines the association of disability with short-term vs. long-term noncompliance of having a mammogram. Methods: Using data from 2016, 2018, and 2020 Behavioral Risk Factor Surveillance System annual surveys, we constructed the study cohort of women aged 55 to 74 years who did not have a cancer history and who received a mammogram at least once in the past. Outcomes are short-term (2 years) and long-term (5 years) noncompliance of USPSTF recommendations. Key independent variables are six binary variables of standard functional disability conditions (hearing, vision, cognition, ambulation, self-care, and independent living) in the first model and a categorized total number of disabilities (0, 1, 2, ≥3) in the second model. We employed a multivariable logistic regression model, adjusting individuals’ socio-demographics, general health status, chronic conditions, health risk factors, and metropolitan statistical areas (MSA), and accounting for complex survey design. Results: Among the study cohort (n = 232,143; weighted n = 29,358,431), 18.1% and 7.1% of women reported not having mammography in the past two and five years, respectively, representing short- vs. long-term noncompliance. Of the study cohort, 32.8% had any type of disability (ambulation 22.7%, cognition 11.0%, independent living 8.8%). Notably, the long-term noncompliance rate was highest among women with a disability and residing in non-MSA (10.2%). In multivariable analysis, while only disability in independent living was associated with short-term noncompliance (odds ratio [OR] 1.28; 95% confidence interval [CI] 1.15-1.42), disability in independent living (OR 1.34; 95% CI 1.18-1.52), vision (OR 1.15; 95% CI 1.01-1.32) and ambulation (OR 1.12; 95% CI 1.01-1.24) were all significantly associated with long-term noncompliance. Women with ≥3 disabilities were 1.64 times more likely to be non-compliant in the long term, and the association of disability with noncompliance was more pronounced in non-MSA. Conclusions: This study provides the first empirical evidence on the positive association between disability and screening noncompliance, especially in the long term. It suggests disability could aggravate disparities in timely access to cancer screening, particularly in non-MSA. Understanding how various types of disabilities affect screening behavior is a critical step for public health efforts in cancer prevention and control through identifying vulnerable subgroups for targeted interventions.
Claims-based cardiac monitoring (CM) in patients (Pts) receiving trastuzumab (TZ).
Authors: Lindsey Bandini, Crystal S. Denlinger, Sarah Ford Duggan Goldstein, Wendy Marinkovich, Stephen B. Edge, Robert W. Carlson
Journal: Journal of Clinical Oncology (2022)

324 Background: TZ in HER2-positive breast cancer (BC) has established improved outcomes in certain Pts. TZ carries a black box warning and a recommendation for CM in all Pts prior to and during treatment (tx) Few studies have evaluated real-world CM compliance during tx. Methods: Retrospective, cross-sectional analysis was conducted to identify CM compliance among BC pts receiving TZ, using a limited data set of administrative claims data consisting of female Pts who were continuously insured over a 24-month period between Jan 1, 2019 and Dec 31, 2020, as provided through a secure portal by Blue Cross Blue Shield Association. [1] . BC diagnosis was confirmed by ICD-9 code, while tx with TZ or biosimilar was confirmed through Healthcare Common Procedure Coding System codes. A care episode spanned 14 months, including 123 days prior to first TZ dose (Index Date) and at least 307 days of follow up. Two cohorts (eligibility for both dx and continually insured status of female commercial Pts, 2018-2019 and 2019-2020) were analyzed across four tx Phases (Pre-Tx Phase [days -123-+ Index Date as day 1], Phase 1 [days 61-123], Phase 2 [days 153-215], Phase 3 [days 245-307]). Phase denominators were calculated independently, only including Pts with ongoing TZ tx for each Phase. [1] Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. Results: Pts in each Phase and cohort ranged from 2,304 (Full Compliance 2019-2020) to 3,263 (Pre-Tx 2019-2020). Similar results were seen in both cohorts, with highest proportion of Pts receiving CM in Pre-Tx phase. Overall compliance in Pre-Tx Phase and all subsequent Phases was low; nearly two-thirds of Pts missed one or more CM tests. Drop-off in CM testing occurred in each subsequent tx Phase (Table). Conclusions: Continued decline in CM over time suggests lack of awareness for potential late TZ cardiac toxicity. Further research regarding why Pts are not receiving recommended baseline and on-treatment CM is needed. Routine CM during TZ tx may be a quality indicator for practices, payers, and quality improvement programs.[Table: see text]
Modifiable risk factors for falls among older adults with advanced cancer.
Authors: Marielle Jensen-Battaglia, Mostafa Refaat Mohamed, Kah Poh Loh, Megan Wells, Rachael Tylock, Erika E. Ramsdale, Beverly Canin, Jodi Geer, Mark Allen O'Rourke, Jijun Liu, Supriya Gupta Mohile, Tanya Marya Wildes
Journal: Journal of Clinical Oncology (2022)

328 Background: Older adults with cancer are more likely to fall than those without cancer, but the factors driving this increased risk are not fully understood. Falls may lead to injury, dependence, hospitalization, and death. Given the interventions available to reduce fall risk, identifying risk factors amenable to intervention for older adults with cancer is critical to provide targeted care and improve health outcomes. Methods: To examine factors associated with patient-reported falls within a 6 month follow up period, we analyzed data previously collected in a nationwide cluster randomized trial (ClinicalTrials.gov: NCT02107443; PI: Mohile, NCORP UG1CA189961). Patients were eligible if age ≥70, stage III/IV solid tumor or lymphoma with palliative treatment intent, and ≥1 geriatric assessment impairment (GA). A GA summary with tailored recommendations was given to oncologists in practices randomized to the intervention, but not usual care. We combined intervention and usual care groups and evaluated baseline risk factors for falls over a 6 month follow up including: prior falls, fear of falling (FOF), activity limitation due to FOF, activities of daily living, Short Physical Performance Battery, Timed Up and Go (TUG), Older Americans Resources Survey (physical health scale), cognition, polypharmacy, potentially inappropriate medications (PIM), and neurotoxic treatment agents. Incidence rate ratios (IRR) were estimated using generalized linear mixed models controlling for the study arm and practice site. Fully adjusted multivariable models were built for factors associated with follow up falls (p≤0.15) in bivariate. Results: Of 541 patients (mean age: 77, SD: 5.27), 140 (26%) patients had prior falls in the past 6 months. Over 6 months of follow up 467 (86%) had falls data for ≥ 1 follow up timepoint and 344 (64%) had complete follow up. Of those contributing any follow up data 103 patients (22%) reported at least one fall. In adjusted models prior falls, impaired TUG, and number of PIM were associated with higher incidence of falls over 6 months (see Table). Conclusions: Prior falls, TUG, and PIM are prospectively associated with falls among older adults with advanced cancer. These factors are feasible to assess and amenable to interventions such as rehabilitation or deprescribing. Future studies focused on implementation of fall risk reduction in the oncology setting are needed to determine the most effective ways to reduce fall risk in this vulnerable population. Clinical trial information: NCT02107443. [Table: see text]
EMR-based clinical decision support to address rising Clostridioides difficile rates in a pediatric hematology/oncology/BMT unit.
Authors: Claire Stokes, Jillian Cotter, Carrye Rudolph Cost, Kathleen McCarthy O'Toole Dorris, Virginia Lugo, Jason Child, Rebecca Coughlin, Stephanie Cox, Keith Hazleton, Samuel Dominguez
Journal: Journal of Clinical Oncology (2022)

383 Background: The transition from conventional microbe detection methods to multiplex polymerase chain reaction-based gastrointestinal pathogen panels (GIP) has contributed to increased detection of Clostridioides difficile. Children undergoing cancer therapy often experience changes in stool patterns that present similarly to infectious diarrhea and they have high rates of C. difficile colonization, potentially leading to excessive testing and attendant false positive detection of C. difficile. In response to rising rates of C. difficile detection in our pediatric inpatient hematology/oncology/BMT unit, we developed and implemented a decision support tool to address rising rates of C. difficile for our population. Methods: A multidisciplinary team was convened in 2018 to develop an evidence-based clinical pathway for stool testing and C. difficile. treatment. A clinical decision support tool was designed and integrated into the electronic medical record (EMR) to guide providers in whether to order C.difficile testing in the presence or absence of broader GIP. This tool incorporated stool quality as documented by the Bristol stool scale and stool frequency, recent laxative administration, age, length of stay, and recent stool testing in order to limit C. difficile testing to those patients with high likelihood of infection. In parallel, a team focused on implementation of appropriate hand hygiene, universal gloving, ultraviolet disinfection, and signage to reduce colonization among our patients. Monthly rates of hospital acquired C. difficile. infections were followed from February 2018 through June 2020. Results: After introduction of the pathway and implementation of the stool testing restrictions, the rate of hospital-acquired C. difficile infection rate decreased from 27.6 to 14.3 infections per 10,000 hospital days a, 48.1% reduction. Conclusions: After implementation of an EMR-based clinical decision support reinforcing evidence-based practice guidelines, we observed a meaningful reduction in C. difficile infections on a pediatric hematology/oncology/BMT unit. Continuous efforts towards environmental changes to reduce colonization in our population potentially contributed to our success.
Oncologists’ attitudes and practices regarding fertility preservation at a tertiary academic center.
Authors: Meera Vimala Ragavan, Vanessa Elaine Kennedy, Rahul Banerjee, Amy M. Lin, Ana I. Velazquez Manana
Journal: Journal of Clinical Oncology (2022)

190 Background: Infertility is a significant long-term consequence of cancer treatment and can negatively impact health related quality of life. As the incidence of cancer rises in younger populations and an increasing number of patients are prescribed systemic therapy in the neoadjuvant and adjuvant settings, the proportion of patients at risk for infertility will rise in tandem. Referrals for fertility preservation (FP), however, are low nationally and at our institution. Our study aimed to characterize oncologist attitudes and practices around FP and identify barriers to FP in patients with cancer. Methods: We developed a 21-item anonymous survey informed by literature review and input from FP stakeholders. The survey was distributed electronically to all faculty and fellows (n = 103) within our division of hematology/oncology during a division-wide conference on FP and subsequently emailed to all faculty and fellows, with three weekly follow up reminder emails. Results: 41 respondents completed the survey (response rate 40%), including faculty (46%) and fellows (39%). Respondents were predominantly male (49%), aged 25-40 (51%), white (44%), and non-Hispanic (73%). Most respondents agreed that FP should be offered to all patients with cancer receiving cytotoxic therapy (95%), however fewer respondents agreed that FP should be offered if it would cause a treatment delay by 2 weeks or more (63%). Respondents felt more comfortable counseling male patients (65%) than female patients (54%) and a larger proportion (41%) knew how to make referrals for sperm preservation (compared to 22% for oocyte preservation). The top barriers to counseling were patient past childbearing age (41%), provider did not remember to discuss (37%), and need for urgent treatment initiation (32%). The top barriers for an interested patient to undergo FP were perceived cost by patient (61%), need for urgent treatment initiation (59%), and patient was too overwhelmed to proceed with FP (42%). Conclusions: Oncologists agreed that FP is an important part of cancer care. However, many stated that cancer treatment initiation was often too time sensitive to counsel patients regarding fertility risks and make FP referrals. The FP referral process was not clear to many respondents. Clinic-level interventions are warranted to ensure timely patient access to FP. Based on the results of this study, we will launch a fellow-led Plan-Do-Study-Act Quality Improvement intervention to increase FP referrals in our clinics.